Vitreous surgery in which the lens slips into the vitreous

Eyeball contusion can often cause rupture of the lens suspensory ligament, lens dislocation or subluxation occurs; at the same time, the lens can be turbid. Removal of dislocated cataract by conventional methods tends to cause vitreous prolapse. At the time of removal, the lens may also fall back into the vitreous cavity, or the lens may be broken. In these cases, secondary glaucoma or lens-derived intraocular inflammation is often combined. Untreated, the visual acuity of the traumatic eye is poor. Vitrectomy can better handle these conditions and avoid some complications of conventional surgical procedures. The main factors that determine the operation are: the amount of lens material, the site of dislocation, the mobility and hardness of the lens, and whether the medium is transparent. Other complications such as retinal detachment, vitreous incarceration, and iris trauma should also be fully considered before surgery for treatment during surgery. Treatment of diseases: ocular trauma Indication The vitreous surgery for the lens to enter the vitreous is suitable for: 1. The lens is broken into the vitreous due to eye contusion. 2. May merge the iris roots or a small amount of blood in the vitreous. Contraindications 1. In the acute phase of trauma, the front of the eye is congested with obvious or accompanied by secondary glaucoma. Vitreous surgery should be considered after inflammation and high intraocular pressure are controlled. For continuous high intraocular pressure, poor response to drugs, and optic nerve damage, ocular hypotension should be considered. 2. With retinal detachment, it should be treated according to the surgical principle of traumatic retinal detachment. Preoperative preparation 1. Improve various examinations, including ocular ultrasound and visual electrophysiological examination. 2. The degree of intraocular lens (posterior or anterior type) should be calculated. Surgical procedure 1. Establish a standard three-channel ciliary body flat vitreous surgery. 2. Cut the vitreous into the anterior chamber, pupil area, and visual axis. 3. According to the hardness of the lens, whether it is adhered to the vitreous, different removal methods can be adopted. Since most trauma occurs in children and young adults, the cutting head alone can perform lens removal in most cases. At the same time, the vitreous around the lens should also be removed. Since the lens is mostly adhered to the vitreous, the lens can be removed by suction when the front and middle vitreous bodies are removed. If the lens is deposited on the retina, it can be attracted by the negative pressure of the cutting head and then removed. If the lens fragments fall into the posterior vitreous, the medial and anterior vitreous cavities should be grasped and resected. For softer lenses, general resection is not difficult. The lens can also be aspirated by an ultrasonic pulverizing head, and then pulverized and sucked out. 4. If the lens nucleus is very hard, or is an old case, the above method is difficult to work, then heavy water should be used, injected into the vitreous cavity, the lens floats to the original lens plane, and then removed by ECCE method. The anterior and peripheral vitreous, as well as the ruptured lens capsule and cortex, must be removed first during surgery. After most of the vitrectomy is completed, it can be seen that the lens nucleus falls on the retina. At this point, a catheter needle with a silicone tube is placed in front of the retina, and a perfluorocarbon solution is injected, and the lens nucleus floats. As the injection continues, the lens floats to the front of the vitreous. Gently push with the catheter needle to stay in the pupil area, which can be delivered through the corneoscleral incision with a lens spoon. In order to avoid possible damage caused by the contact of the perfluorocarbon solution with the corneal endothelium, balanced saline perfusion is maintained in the anterior chamber when the lens is delivered. After the lens was removed, the limbal incision was sutured and the perfluorocarbon liquid was aspirated with a catheter needle. 5. Intraocular lens can be implanted without examination of retinal detachment or other complications. 6. Suture the incision. complication Chasing hard cores or fragments thereof on the posterior vitreous cavity or retinal surface may cause retinal damage or holes. Once it occurs, it should be treated as a retinal detachment.

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